Endoscopic Cyclophotocoagulation in Asian Patients

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Endoscopic Cyclophotocoagulation in Asian Patients

• Dr Boon-Ang Lim (MBBS, FRCS, MRCOphth)
• Consultant
• Cataract and Glaucoma Service
• The Eye Institute at
• Tan Tock Seng Hospital
• Singapore

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Endoscopic Cyclophotocoagultion(ECP) in Asian
Patients

• Purpose To report the safety efficacy of ECP
  for the treatment of glaucoma in Asian patients
• ECP technology light, laser camera housed in
  single G 19 probe
• Machine E2 from Endo-optiksTM
• Light175 Watt Xenon
• Laser
• 810 nm Diode laser
• 640 nm Diode Laser Aiming Beam
• Image
• High Resolution Toshiba Camera
• 110? field of view

3 in 1 technology in ECP
ECP probe
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ECP in Asian Patients methods

• Retrospective, non randomized study of
  consecutive cases performed by 1 surgeon in a
  tertiary hospital

• Indications for surgery
• Pseudophakics, glaucoma not controlled 2
  anti-glaucoma medications
• Patient with significant cataract, 1anti-
  glaucoma meds

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ECP in Asian Patients Results

• 28 eyes of 27 patients were studied
• Follow up 8.7(SD 4.4) months
• Male to female ratio 1215
• Age range52 to 91 years, mean 74.4 (SD9.9)
• OD OS 217

• Diagnoses
• POAG7
• CACG7
• NTG 3
• Rubeotic3
• Aphakic 2
• OHT2
• Pseudoexfiolation2
• Secondary angle closure glacuoma1

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ECP in Asian Patients Procedures done

• Phaco/IOL/ECP 16 (57.1)
• ECP9 (32)
• ECCE/IOL/ECP 2 (7.1)
• ECCE/ECP1 (3.6)
• 3 quadrants treatment
• Pre op Diagnoses, IOP, visual acuities, anterior
  segment findings

• Post op reviews First day, 1 week, 1 month, 3,
  6, 12th month
• Parameters taken Visual Acuity, anterior chamber
  reaction, IOP, pain

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ECP in Asian patients Results

• Pre op IOP 22.4(SD6.0)mmHg
• Post-op IOP 14.8(SD5.1)mmHg
• Statistically significant paired T test,
  Wilcoxon Signed Ranked test, p0.004

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ECP in Asian Patients Results
0 pre op, 1at 3 months, 2 at 6months, 3 at 12
months, scattered dots outliers
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ECP in Asian Patients Results

• Number of anti-glaucoma medications pre-op
  2.04(SD 0.84)
• Number of anti-glaucoma medications post op at 12
  months 1.38 (SD1.23), paired T test,
  statistically significant, p0.016)

• 12 (42.9) not on medication
• 4 ( 14.3) on 1 medication
• 9 on 2 medications(32.1)

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ECP in Asian Patients Results

• 3 (10.7) failures 2 Pseudoexfiolation glaucoma,
  one 20 CACG
• 67 success at 1 year (IOP lt 21mmHg meds)

• 3 (10.7) cases of visual deterioration
• CF to NPL significant, wipe out
• (rubeotic)
• 6/24 to CF significant
• (aphakic glaucoma)
• 6/60 to CF significant
• (CACG)

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ECP in Asian patients Complications

• Aphakic retinal detachment hypotony (1)
• Hyphema(1)
• Iris burn (2)
• No case of infection

?
Iris burn at pupil margin
Iris burn (arrow) at 1st (top) and 3rd month
(bottom) in same patient
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ECP Literature review

• The Clinical study of ECP on management of
  refractory glaucoma Zhonghua Yan Ke Za Zhi2006
  Jan42(1)27-31
• N51
• Success 76.1 at 1 yr (IOP lt21mmHg meds)
• ECP for treatment of refractory glaucoma AJO
  1997 Dec124(6) 787-96
• N68
• Success 94 at 1 yr, 82 at 2 yr (IOP lt 21mmHg
  meds)

• Prospective, comparative study between ECP
  Ahmed drainage tube implant in refractory
  glaucoma, J Glaucoma2004 Jun13(3)233-37
• N 68
• Success (IOPlt21mmHg meds) 94 at 1 year 82
  at 2 years

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ECP in Asian Patients Conclusions

• ECP relatively pain free, safe and effective
• Aphakic cases may need vitrectomy

• Potential indications for ECP
• - refractory glaucoma with significant
  cataract and some visual potential
• - patients with active blepharitis and where
  MMC trab carries long term risk of infection
• - cases of failed TCP